New Vaccines Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia.
Children's Hospital 1, Ho Chi Minh City, Viet Nam.
Vaccine. 2023 Nov 2;41(46):6782-6790. doi: 10.1016/j.vaccine.2023.09.003. Epub 2023 Sep 9.
New prevention strategies for respiratory syncytial virus (RSV) are emerging, but it is unclear if they will be cost-effective in low- and middle-income countries. We evaluated the potential impact and cost-effectiveness of two strategies to prevent RSV disease in young children in Vietnam.
We used a static cohort model with a finely disaggregated age structure (weeks of age <5 years) to calculate the RSV disease burden in Vietnam, with and without a single dose of maternal vaccine (RSVpreF, Pfizer) or of monoclonal antibody (Nirsevimab, Sanofi, Astra Zeneca). Each strategy was compared to no pharmaceutical intervention, and to each other. We assumed both strategies would be administered year round over a ten-year period. The primary outcome measure was the cost per disability-adjusted life year (DALY) averted, from a societal perspective. We ran probabilistic and deterministic uncertainty analyses.
With central input assumptions for RSVpreF vaccine ($25/dose, 69 % efficacy, 6 months protection) and Nirsevimab ($25/dose, 77 % efficacy, 5 months protection), both options had similar cost-effectiveness ($3442 versus $3367 per DALY averted) when compared separately to no pharmaceutical intervention. RSVpreF vaccine had a lower net cost than Nirsevimab (net discounted cost of $213 m versus $264 m) but prevented fewer RSV deaths (24 % versus 31 %). Our results were very sensitive to assumptions about the dose price, efficacy, and duration of protection. At $5/dose and a willingness-to-pay threshold of 0.5 times the national GDP per capita, both prevention strategies have the potential to be cost-effective.
RSVpreF vaccine and Nirsevimab may be cost-effective in Vietnam if appropriately priced.
新的呼吸道合胞病毒（RSV）预防策略正在出现，但尚不清楚它们在中低收入国家是否具有成本效益。我们评估了两种在越南预防幼儿 RSV 疾病的策略的潜在影响和成本效益。
我们使用具有精细细分年龄结构（<5 岁周龄）的静态队列模型来计算越南的 RSV 疾病负担，包括使用和不使用单剂量母体疫苗（RSVpreF，辉瑞）或单克隆抗体（Nirsevimab，赛诺菲，阿斯利康）的情况。每种策略都与无药物干预以及彼此进行了比较。我们假设这两种策略都将在十年内全年进行管理。主要的结果衡量标准是从社会角度来看，每避免一个残疾调整生命年（DALY）的成本。我们进行了概率和确定性不确定性分析。
使用 RSVpreF 疫苗（25 美元/剂，效力 69%，保护期 6 个月）和 Nirsevimab（25 美元/剂，效力 77%，保护期 5 个月）的中央输入假设，两种方案单独与无药物干预相比，成本效益相似（每避免一个 DALY 的成本分别为 3442 美元和 3367 美元）。RSVpreF 疫苗的净成本低于 Nirsevimab（净折扣成本分别为 21.3 亿美元和 26.4 亿美元），但预防 RSV 死亡的人数较少（24%对 31%）。我们的结果对剂量价格、效力和保护期的假设非常敏感。如果价格合理，这两种预防策略都有可能在越南具有成本效益。
如果价格合理，RSVpreF 疫苗和 Nirsevimab 可能在越南具有成本效益。
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